SFA or CSFA

Surgical First Assistant (SFA or SA) or Certified Surgical First Assistant (CSFA)

Surgical First Assistants practice under the direct supervision of surgeons in many hospitals, medical centers, and outpatient surgery centers.

A SFA is granted privileges to practice at these facilities either as an employed surgical first assistant, or following a thorough review by a medical credentials committee called a credentialing process. Billing practices for the first assistant vary from state to state and/or insurance company. 

The SFA must maintain medical malpractice insurance and are subject to the rules, regulations, and bylaws of the facility that they practice within. 

The terms Surgical Assistant, Surgical First Assistant, Registered Nurse First Assistant, Certified Nurse First Assistant (CRNFA), and Certified Surgical First Assistant (CSFA) describe individuals who routinely assist surgeons with many types of surgical procedures.

The qualifications of the person may vary with the nature of the operation, the surgical specialty, and the type of hospital or ambulatory surgical facility.  The American College of Surgeons supports the concept that, ideally, the first assistant at the operating table should be a qualified surgeon or a resident in an approved surgical education program.  However, it may become necessary to utilize nonphysicians as first assistants.  A Surgical Assistant (SA) or physician assistant (PA) with additional training should meet national standards and be credentialed by the appropriate local authority.  These individuals are not authorized to operate independently.

What does a Surgical Assistant do?  The first assistant during a surgical operation should be a trained individual who is able to participate in and actively assist the surgeon in completing the operation safely and expeditiously by helping to provide exposure, maintain hemostasis, tie or sew, and serve other technical functions.

The surgical assistant is limited to performing specific functions as identified by the medical staff bylaws, rules and regulations. These generally include such statements as aiding in maintaining adequate exposure in the operating field, cutting suture materials, clamping and ligating bleeding vessels, and, in selected instances, actually performing designated parts of a procedure.

A designated first assistant cannot be involved in any other role or function during the surgical procedure such as the scrub role (passing instruments). Simple procedures such as a hernia repair do not require a first assistant.

Education:  Graduate of an approved CAAHEP or NASC recognized program.   Programs vary in length from 9 months to 24 months.

Types of Surgical Assistants: CSFA - Certified Surgical First Assistant; CRNFA or RNFA - Registered Nurse First Assistants; PA- Physician Assistants who have received additional training. For more information go to Association of Surgical Assistants; Association of Perioperative Nurses; or the American Academy of Physician Assistants.

Credentialing organizations include the National Board of Surgical Technologists and Surgical First Assistants, and the Competency Credentialing Institute. For more information go to Association of Surgical Assistants; NBSTSA - Certification Exam Testing Organization; or NASC-CRNFA Certification Exam Organization and RNAS-C "Registered Nurse at Surgery Certified" or "Certified Register Nurse First Assistant (CRNFA)" for national information.

For a statement by the American College of Surgeons on the role of the first assistant go to  American College of Surgeons Statement on First Assisting .